Mosepele Mosepele, Molefe-Baikai Onkabetse J, Grinspoon Steven K, Triant Virginia A
Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
Curr Infect Dis Rep. 2018 May 26;20(8):20. doi: 10.1007/s11908-018-0628-7.
HIV-infected patients face an increased risk for cardiovascular disease (CVD), estimated at 1.5- to 2-fold as compared to HIV-uninfected persons. This review provides a recent (within preceding 5 years) summary of the role of statin therapy and associated role in CVD risk reduction among HIV-infected patients on anti-retroviral therapy.
Statins remain the preferred agents for reducing risk for CVD among HIV-infected populations based on guidance extrapolated from general population (HIV-uninfected) cholesterol treatment guidelines across different settings globally. However, HIV-infected patients are consistently under prescribed statin therapy when compared to their HIV-uninfected counterparts. The most commonly studied statins in clinical care and small randomized and cohort studies have been rosuvastatin and atorvastatin. Both agents are preferred for their potent lipid-lowering effects and their favorable or neutral pleotropic effects on chronic inflammation, renal function, and hepatic steatosis among others. However, growing experience with the newer glucuronidated pitavastatin suggests that this agent has virtually no adverse drug interactions with ART or effects on glucose metabolism-all marked additional benefits when compared with rosuvastatin and atorvastatin while maintaining comparable anti-lipid effects. Pitavastatin is therefore the statin of choice for the ongoing largest trial (6500 participants) to test the benefits of statin therapy among HIV-infected adults. Statins are underutilized in the prevention of CVD in HIV-infected populations based on criteria in established cholesterol guidelines. There is a potential role for statin therapy for HIV-infected patients who do not meet guideline criteria which will be further delineated through ongoing clinical trials.
与未感染艾滋病毒的人相比，感染艾滋病毒的患者患心血管疾病（CVD）的风险增加，估计高出1.5至2倍。本综述总结了近期（过去5年内）他汀类药物治疗的作用以及在接受抗逆转录病毒治疗的艾滋病毒感染患者中降低CVD风险的相关作用。
根据全球不同环境下普通人群（未感染艾滋病毒）胆固醇治疗指南推断的指导意见，他汀类药物仍然是降低艾滋病毒感染人群CVD风险的首选药物。然而，与未感染艾滋病毒的患者相比，感染艾滋病毒的患者接受他汀类药物治疗的比例一直较低。临床护理以及小型随机和队列研究中最常研究的他汀类药物是瑞舒伐他汀和阿托伐他汀。这两种药物因其强大的降脂作用以及对慢性炎症、肾功能和肝脂肪变性等方面的有利或中性多效性作用而成为首选。然而，新型葡萄糖醛酸化匹伐他汀的经验不断积累，表明该药物与抗逆转录病毒疗法几乎没有不良药物相互作用，对糖代谢也没有影响——与瑞舒伐他汀和阿托伐他汀相比，这些都是显著的额外益处，同时保持相当的抗血脂作用。因此，匹伐他汀是正在进行的最大规模试验（6500名参与者）中测试他汀类药物治疗对艾滋病毒感染成年人益处的首选他汀类药物。根据既定胆固醇指南的标准，他汀类药物在艾滋病毒感染人群中预防CVD方面未得到充分利用。对于不符合指南标准的艾滋病毒感染患者，他汀类药物治疗可能具有一定作用，这将通过正在进行的临床试验进一步明确。
